The projects reflect the findings that over the last decade, government policy has increasingly recognised the importance of community engagement of community engagement in the design and delivery of public services.

Self-Harm Self-Help is a four year project which aims to gather data on how prevalent the issue of deliberate self-injury is in Bridgend County.

What is Self-Harm?Self-harm is an umbrella term for any action, habit or behaviour which can cause damage to your health. It takes many different forms and as an individual act is hard to define. However in general, self-harm is the act of deliberately causing harm to oneself, either by causing a physical injury, by putting oneself in dangerous situations and/or self-neglect.

Self-Harming is a serious public health problem and results in significant social and economic burden to health services, particularly with respect to unscheduled hospital care to treat injury/overdose.

The UK has one of the highest self-harm rates in the whole of Europe with 400 reported cases per 100,000 people.

Out of those people, it is estimated that 87% will seek no treatment, and that 5% will die by suicide within 15 years of the initial attempt.

According to figures released in the document, there are approximately 5,500 admissions for self-harm in Wales each year.

This figure does not, however, take into account those assessed in A&E departments who do not require admission, or the many more who do not attend following an incident of self-harm.

While there have been improvements in how services respond to people, too often those who present in distress still feel stigmatised for their self-harm and suicidal behaviours.

There was a story in the news recently from Scotland where a student, after building the courage to visit the GP, was told she couldn’t be suicidal as her clothes were too clean.

This is the attitude that people fear. This is why a staggering 75% of people with mental health problems do not access statutory services at all due to the perceived stigma attached.

Those who are the first point of contact should see this as an opportunity for intervention, and as such, need to have the necessary knowledge, skills and attitudes to ensure that compassionate and supportive evidence based care is delivered.

MythsThere are many misconceptions about ‘the type of people who self-harm’. Let’s address some of those here

They only do it for attention.
Self-harm is usually a very private, personal act. People who self-harm tend to cover their wounds, or harm in places invisible to everyday eyes. When attention is drawn to their injury, it will often be negative and increase distress.

The wound isn’t bad so the problem can’t be bad.
The severity of the wound is unimportant. The fact that someone is self-harming indicates they are in need of help and support. If you notice that someone is harming themselves, your reaction can be crucial. Dismissing the injury is belittling to the person who no doubt already feels misunderstood and run down.

Only teenage girls self-harm.
Although the majority of people who disclose self-harming behaviour are teenage girls, self-harm is definitely not something that just affects young people or women. It is estimated that out of the staggering amount of hospital admissions for self-harm related injury in Wales last year, 11% were male.

It is widely believed that many more males self-harm, but there is a greater stigma to come forward. There has always been shame and secrecy around self-harm for any age and gender, but the ‘boys don’t cry’ attitude leaves many suffering in silence, unable to seek help and support.

It is also apparent that the way in which many boys and men self-harm, fighting, hitting and punching walls is not always recognised as self-harm, despite following many of the same behavioural and emotional patterns and internal processes.

Welsh Government research shows that women aged between the ages of 15-19 have the highest prevalence of self-harm in Wales. What we have found through our own research is that the highest numbers of incidents in Bridgend County are women in the 41-50 age range. In fact, over 24% of people actively engaged in the project are over the age of 50. Welsh Government’s research also suggests an increase in self-harm in males over the age of 85.

Why do people self-harm?There is no one reason for self-harming. What we find is that there are common themes:

Relieving unbearable feelings such as grief, sadness or anger.Self-punishmentdue to feelings of self-hatred, shame, guilt and ‘dirtiness’ (self-harm is often used as a means to ‘cleanse’ oneself.Feeling ‘Real’ – often people harm themselves as a way to connect their minds and body, it is easier sometimes to deal with physical pain than emotional pain.Control Self-harming allows an amount of control in the lives of those who feel overwhelmed with the difficulties they face, or the pain they feel inside. Often, it can be away for the person to punish themselves for perceived failures in their own lives.

In older people, self-harm is more often linked to loss, loneliness and social isolation, but again, as with self-harming in any age group, there really is no single motivation that causes a person to harm themselves. Ultimately, self-harm is a coping strategy and one that can be replaced by healthier mechanisms.

One area of self-harm in older people that requires further research is how many begin self-harming in old age and how many have continued in to old age. Research does show that many cases of self-harm in older people stem from failed attempts at suicide.

SuicideWhat we know about self-harming in the younger generation is that while there is a relationship between suicidal tendencies, self-harming does not necessarily mean a person wishes to take their own life. With the older generation, it appears that self-harming is much more likely to result in completing suicide.

Statistics indicate that while suicide rates amongst older people are steadily falling, reported cases of deliberate self-harm rates are rising. This could be because more older people are self-harming, or it could be that people are more willing to speak out about their self-harm.

The scope of what is considered self-harm behaviour is also widening, and older people tend to self-harm in different ways to their younger counterparts.

Unlike the young, elderly people who self-harm could be more likely to behave in such a way as to hasten death. This can involve taking a passive role in their own care, not looking after themselves when physically able to do so, under eating and excessive drinking, refusing medical treatment.

These forms of passive self-harm are more common in the older generation than the physical, deliberate injury generally associated with the younger generation.

The British Journal of Psychiatry admits that self-harm in older people is under researched, and that more awareness is needed in services for older people as numbers are predicted to keep on rising.

Self-Harm to Self-CareSince beginning the project, one of the areas we’ve been researching is what support is available for local people who self-harm, and what services they would like to see. Based on those findings, MHM Wales started the first Self-Harm to Self-Care workshop in February of last year.

These workshops provide a safe, welcoming atmosphere where participants are helped to identify and express their feelings, build their confidence and learn alternative coping strategies. The workshops run for 8 weeks and have a maximum of 12 participants.

We ask participants to fill in various evaluation forms at the beginning and end of the workshops to allow us to see how useful the workshops are to them. I’m happy to say we have received nothing but positive feedback and thus the workshops have continued.

Next workshop starts on Wednesday 24th February

These workshops focus on reducing self-harm by:

Providing a safe space to share feelings, thoughts and concern

Helping to identify and express feelings appropriately.

Teaching healthy communication skills

Learning to treat yourself and others with respect

Encouraging responsibility for our own lives and choices

When the first workshops ended in March 2015, participants expressed a desire to continue to build upon the good foundations and friendships they had built during the workshops, and a peer support group, Archways, was set up.

Why Archways? The group decided on the name as symbolic of what the group stands for – an archway can provide shelter, but is not a permanent stopping place. The groups are a place that anyone who has been on the MHM Wales’ Self-Care workshops can go for a ‘top-up’ whenever they feel they need to. The group remains supportive and pressure free and carries over the same ideals and confidentiality of the Self-Care Workshops. Although they are currently for workshop participants, it is likely that the group will open up to non-workshop participants in the future, or a new peer support group can be set up, but this is down to the needs of the community.

What can you do?If a person you know is harming, it is not expected that you will be able to solve their problems, but, as when dealing with any mental or emotional distress, try to be patient, sympathetic and understanding.